The estimated cost of National Health Insurance (NHI) would range from $362 million for a basic benefits package to $633 million for an expanded benefits scenario, according to a report completed by Costa Rican consultants Sanigest Internacional. The consultants have turned in a near 500-page report obtained by The Nassau Guardian. The report is dated October 2, 2014 and outlines various scenarios for NHI. It also provides a comprehensive review of the health care sector in The Bahamas.
The NHI system will be compulsory and all legal residents will be required to participate, the report says. This includes the employed, self-employed, unemployed, non-economically active, retirees and children. Although undocumented migrants will not be explicitly covered under NHI they will continue to receive access to certain services.
"It is estimated that in 2016, a total of 200,000 people will be direct contributors to NHI, and that government will sponsor contributions for children under 18 who are not employed, individuals 18 to 24 years old pursuing higher education and not employed, and the adult non-working indigent, totaling 122,000 people," the report says.
The report notes that the definition of the benefits package is the cornerstone of any health insurance system. It points out that each of the benefit packages outlined includes a different level of services, targets a smaller, or larger, share of the population and considers different levels of utilization depending on the level of co-payments and access.
The most basic package proposed by Sanigest, the Vital Benefits Package, would cover all essential and medically necessary services. It would cost $362 million, assuming 85 percent of the population enrolls. Three key components are left out of the package: dental care, eyeglasses and pay for performance.
The Core Benefits Package would include access to a wider range of services. The total estimated cost of this package would be $505 million, representing a 42 percent increase over the cost of the Vital Benefits Package. The report says the Core Benefits Package would provide a generous level of coverage with limited financial co-payments for the population.
The Expanded Benefits Package would include an even wider offering of services. The total estimated cost of this package would be $633 million, representing a 78 percent increase over the cost of the Vital Benefits Package. Under this scenario, NHI administrative costs increase to eight percent and hospital and other service costs increase significantly. This scenario considers loose controls on utilization and limited control of chronic disease through active case management.
"What needs to be decided going forward is which package is feasible and desirable in The Bahamas given the decisions regarding financing options," Sanigest says.
The consultants also provide options for how NHI could be funded. In 2012, Minister of Health Dr. Perry Gomez had promised NHI within the first year of a new PLP term. He said last week no decisions have yet been made regarding financing the plan. For that and other angles from the report, see today's National Review section.
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